title: Typical takotsubo cardiomyopathy in suspected ST elevation myocardial infarction patients admitted for primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Takotsubo cardiomyopathy (TCM) is increasingly being recognised in patients admitted with suspected acute coronary syndrome, as access to angiography and echocardiography is much quicker than before. We aimed to analyse the prevalence of typical TCM in patients admitted for primary percutaneous coronary intervention (PPCI) with suspected ST elevation myocardial infarction (STEMI) to a single tertiary centre in United Kingdom.
  
  
  METHODS
  All patients admitted to our unit with suspected STEMI from September 2009 to November 2011 were included for analysis.
  
  
  RESULTS
  Of the 1875 patients admitted, 17 patients (all female) with mean age of 69±11.9 yrs were identified to have clinical features of typical TCM, thus giving an overall prevalence of 0.9% in PPCI admissions (3.2% prevalence in women). The admission ECG showed ST elevation in 14 patients (82%) and 3 had LBBB (18%). In the 16 patients who had raised hs Troponin (normal range <14), the mean level was 921±668 (median 778, range 110 to 2550) ng/L. Two patients survived cardiac arrest and one had apical thrombus on presentation. Left ventricular function was severely impaired (EF ≤30%) in 2 patients, whilst it was moderately impaired (EF 31-50%) in others. During a mean follow-up period of 22±7 months (range 8-36 months), there was no mortality or recurrence.
  
  
  CONCLUSIONS
  This is the first observational study to report the prevalence of typical TCM in patients admitted for PPCI in "real-world" practice. Though this condition is not benign during the acute episode, there is a good survival outcome if managed appropriately during the acute phase.
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom. Electronic address: refais@gmail.com.
authors.forename: Refai
authors.initials: R
authors.lastname: Showkathali
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Hetalkumar
authors.initials: H
authors.lastname: Patel
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Anil
authors.initials: A
authors.lastname: Ramoutar
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Alamgir M
authors.initials: AM
authors.lastname: Kabir
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Sayer
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Clesham
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Aggarwal
authors.affiliation: Department of Cardiology, The Essex Cardiothoracic centre, Essex, United Kingdom.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kelly
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D012189:Retrospective Studies; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Apical ballooning syndrome; Broken heart syndrome; Echocardiography; STEMI